What is “adequate testing”, anyway?

The projected deaths numbers below are all significantly lower than yesterday’s, which probably means we’ve passed the peak of another in the regular 7- or 8-day (almost all 7-day) cycles in the 3-day rate of increase in total deaths. I wondered yesterday if this would happen, and sure enough it did – but I still have no idea about why that is happening (if anyone does, please let me know).

However, what does this big change mean in actuality? At the bottom of the table, projected deaths per day in June fell from about 8,800 in yesterday’s post to 6,649 today. However, that just means that one person will die of Covid-19 every 12 seconds in June vs. every 10 seconds, as I projected yesterday. Cause for celebration? Hardly. Once again, this shows the power of exponential growth – what looks like a substantial change given today’s level of deaths is much smaller, given the level that will be in place at any time in the future.

My post yesterday mentioned more than once that the level of testing is very inadequate. Yesterday, someone questioned that, pointing out that everybody who has symptoms is being tested now. I don’t dispute this, although the other question is how quickly they’re getting their results back. A few weeks ago, it was common to wait two weeks for your results, which is of course close to useless, since you’ll either be dead or recovered by then.

But the question of whether there’s adequate testing available depends very much on your purpose. I see three purposes for asking that question:

First, if your purpose is to make sure that everyone with symptoms is tested, then today’s level is probably adequate. But the problem is that there are a huge number of people who a) are sick but don’t have symptoms yet (I’ve heard estimates that people can go 2-3 days in that state, during which time they’ll likely be infecting others); or b) have the disease but will never have symptoms.

One of the biggest problems with controlling the novel coronavirus is that there are such a huge number of asymptomatic cases, since these people never even think about getting tested, yet they spread the disease just as effectively as someone who has symptoms but keeps interacting with people anyway. The asymptomatic people spread it, yet a certain percent of the people they spread it to will be asymptomatic. Those people will then spread it to other, since they’ll never be tested, and on and on. Of course, since we now know that the novel coronavirus was spreading in the US in January if not earlier, the fact that this has been going on the whole time – and the authorities have never had the tests available to find out if it’s happening - is the main source of the dilemma we’re now in.

When I first started writing this blog around March 12, epidemiologists were saying that there are 5-10 times as many infected people as ones who show symptoms. But that number is surely much higher now, because of the compounding spreading since then. The disease will only be controlled when all asymptomatic people are identified and quarantined, and their contacts are identified and quarantined.

So this leads to the second purpose of testing: To find everybody who is infected, not just the ones showing symptoms. For that purpose, we need in principle to test everybody – and do it regularly, since obviously somebody could be virus-free one day, but the next day they will be infected. Of course, it will be impossible to do this for the whole population, but there are lots of ways to target testing at people who are more likely to be infected than others.

Yet doing this level of testing is still a pipe dream, since nowhere near that level of testing is available. We’re currently doing about 250,000 tests a day, but it would need to be at least 2-3 million for this to be possible. However, keep in mind that we’ll never get people to feel good about going to a workplace and shopping until at least this level of testing is being done – since they will never be confident that the person next to them isn’t infected but has no idea they are. Any hope of completely reopening the economy before this happens is a complete pipe dream (this also requires extensive contract tracing capability, of course). The current administration seems to think that, simply by denying this is the case, they can make this problem magically go away and give people confidence to go to work and shop. This simply won’t happen, and this will be very clear in a month or so – in states that are now trying to widely reopen while still having no idea of who is infected.

The third level of testing is what I referred to in my post yesterday. This is where everybody in a workplace is tested at least once a week, and preferably every day. The White House (inadvertently, of course) confirmed the importance of this when they proudly announced two days ago that everybody who interacts with president Trump is being tested every day. I said yesterday that this needs to be done for all workplaces, but I would be happy to see it done at least once a week in every workplace – and it needs to be made mandatory, with anyone who tests positive being sent home to quarantine, with full pay of course. Plus proper social distancing guidelines need to be followed, although the WH just suppressed what looks like it would have been a very good guide, prepared by the CDC, on what kind of measures various workplaces should put in place.

This level of testing will without doubt require tens of millions of tests per week, but – again – I see no way that people will feel comfortable coming into an office or factory, when a) they still don’t know whether the person next to them is infected, and b) there are no official guidelines on how to make a workplace safe – so they just have to trust their employer to know this intuitively and to act with the best interests of their workers at heart.

Of course, I’m not going to say that the economy can’t restart at all before this third level of testing happens, since a lot of people will feel compelled to go back to work, even though they don’t feel safe. And it seems many people in some state capitals, Congress and the White House think we need to just let the current level of unemployment benefits run out, so that people will be forced to return to work, safe or not. As Texas Lieutenant Governor Dan Patrick said recently, “There are more important things than living.” Now, there’s a man who has his priorities right!

The numbers

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into these numbers – they are all projections based on yesterday’s 3-day rate of increase in total Covid-19 deaths, which was 9%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of a treatment). Yet I still think there’s some value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen if there are no intervening changes.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Pct. Change from previous month
March 7	18	3
March 14	38	5
March 21	244	35
March 28	1,928	275
Month of March	4,058	131
April 4	6,225	889
April 11	12,126	1,732
April 18	18,434	2,633
April 25	15,251	2,179
Month of April	59,812	1,994 (= 1 death every 44 seconds)	1,474%
May 2	13,183	1,883
May 9	13,924	1,989
May 16	17,671	2,524
May 23	20,753	2,965
May 30	26,939	3,848
Month of May	87,041	2,808 (= 1 death every 31 seconds)	146%
June 6	31,866	4,552
June 13	37,424	5,346
June 20	48,579	6,940
June 27	57,462	8,209
Month of June	199,456	6,649 (= 1 death every 13 seconds)	229%
Total March - June	350,367

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 78,622

Increase in deaths since previous day: 1,694 (vs. 2,129 yesterday)

Percent increase in deaths since previous day: 2% (vs. 3% yesterday)

Yesterday’s 3-day rate of increase in total deaths: 9% (This number is used to project deaths in the table above. It was 10% yesterday)

II. Total reported cases

I no longer pay any attention to the reported case number. It is a huge underestimate of actual cases, which is probably 10-50 times reported. This is because of the huge shortage of testing capacity. If reported cases is anywhere near actual cases, we would need to be doing 20-30 million tests a week. I believe the US has done about 6 million tests since the start of the pandemic.

Total US reported cases: 1,322,223

Increase in reported cases since previous day: 29,600

Percent increase in reported cases since yesterday: 2%

Percent increase in reported cases since 3 days previous: 7%

III. Reported case mortality rate so far in the pandemic in the US:

Total Recoveries in US as of yesterday: 223,749

Total Deaths as of yesterday: 78,622

Deaths so far as percentage of closed cases (=deaths + recoveries): 26% (vs. 26% yesterday) Let’s be clear. This means that, of all the coronavirus cases that have been closed so far in the US, 26% of them have resulted in death. Compare this with the comparable number from South Korea, which is below 3%. The main reason this number is so high is that total recoveries are so low. I’ve been assuming since March 26, when the recoveries number was first published, that it would rise, so that the estimated case mortality rate (which was 41% on March 26), would be far lower than it is now. If this number really stays at this level, this means the actual case mortality rate in the US is very high, comparable with Italy and France. Unless that comes down soon, we’re in huge huge huge trouble, vs. just huge huge trouble, as is apparent today.

I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com